A new model of HIV care management. Dr Simon Barton London UK

Transcription

1 A new model of HIV care management Dr Simon Barton London UK

2 Current care pathways HIV patients managed by specialists Confidentiality level set by patients Specialist monitoring including lab tests Antiretroviral therapy (ART) prescribing involving multi drug therapy (MDT) Non ART prescribing mainly instigated by specialists and communicated to GPs ONLY with patient consent

3 Future challenges? Managing ART and pathology costs Devolving non ART care/management of comorbidities to GP/other specialties Ensuring continued focus on prevention and STI screening Maintaining confidentiality and choice

4 ART and pathology costs Included in payment by results (PbR) tariffs? Specialist MDT role in management? Role of tendering and procurement? Who gets the savings e.g. VAT? How to refresh if new data vs. cost? Role of clinical trials/research in UK?

5 Role of GPs in HIV care Management of non HIV related conditions (e.g. asthma) best done in GP to NICE/NSF standards Encourage patients to register with GPs Ask GP prescribe/take over responsibility for that part of patient care? Resources to support this transition-training, immediate advice, community nurse specialist

6 But Complex drug interactions lead to errors (e.g. statins) How to share pathology results and avoid duplication Governance and safety and confidentiality

7 Principle Should an HIV infected patient only be able to access comprehensive and competent clinical care by registering with a GP and only if using a NHS ID number?

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9 Health and Social Care Act 2012 Strategic health authorities (SHAs) abolished and 151 Primary Care Trusts (PCTs) replaced by 250 GP consortia Effect of change on Medical Education and training All Hospitals to Foundation Trusts by 2014 (but what if not?) Mergers, acquisitions, tendering, AQP and OFT

10 HIV commissioning National basis to ensure equity of open access, standards and optimise public health priority National basis to ensure efficiency of procurement for specialised therapy and pathology Local provision by managed clinical networks to ensure governance and optimise use of clinical resources

11 Creation of Clinical Reference Groups (CRGs) 76 specialised services to be Nationally commissioned i.e. not commissioned by GP led consortia locally HIV CRG formed in Jan 2012 Patient and carer representation Clinical majority regional representation and responsibility Define service specification

12 Service based on outcome and access New HIV dataset HARS New National Tariff for HIV outpatients Clear standards of Care BHIVA 2013 Separation of GUM/Sexual health and HIV Adult and Paediatric HIV specialist care commissioned together BUT? HIV prevention? Testing? Community? Public Health?

13 CRG membership Chair Simon Barton Commissioner Claire Foreman North East Edmund Ong Manchester/Lancs/Cumbria Ed Wilkins Cheshire & Mersey Mas Chaponda Yorkshire & Humber Christine Bowman West Midlands Stephen Taylor East Midlands Adrian Palfreeman East of England Nelson David

14 CRG members South West Mark Gompels Wessex Cecilia Priestly Thames Valley Chris Conlon South East Coast Martin Fisher London (North West) Brian Gazzard London (North East) Ian Williams London (South) Derek Macallan

15 CRG Organisations; BHIVA Duncan Churchill BASHH Simon Edwards CHIVA Fiona Thompson NHIVNA Eileen Nixon Patient and Carer Members; Memory Sachikonye Paul Clift Garry Brough Abi Carter

16 YES! Reduce management overhead by larger clinical teams Use leverage of size to procure at best price for ART and pathology tests Reduce drug and lab cost waste Reduce clinical error Improve outcome by reducing late diagnosis

17 Introducing the core recommendations Chronic disease model, retaining case management by specialists Specialised commissioning of managed clinical networks over wide areas Structure of networks and patient pathways Professional education and accreditation Record keeping and information sharing Normalisation of HIV testing

18 Perils ahead Local race for savings undermines service standards Tendering and commissioning entropy causes fragmented services with inequitable care Concentrating on cost cutting without measuring outcomes may cause harm and incur greater cost QIPP includes Quality we must argue and use data to preserve through the hard times ahead

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